Value-Based Care

High costs associated with specialty pharmacy will necessitate the evolution of a new specialized model to help ensure that patients are receiving the financial assistance they need and adhering to their treatment, according to Steve Miller, MD, senior vice president and chief medical officer of Express Scripts.

Accountable care organizations have to work more on engaging physicians in meaningful leadership roles and should focus on learning about patient goals, said James Whitfill, MD, chief medical officer of Scottsdale Health Partners.

In order for accountable care organizations to overcome short-term thinking they must be careful with their fee-for-service codes and ensure that people are using the system responsibly, Farzad Mostashari, MD, chief executive officer of Aledade, said at the National Association of ACOs Spring 2016 Conference.

At the spring live meeting of the ACO & Emerging Healthcare Delivery Coalition in Scottsdale, Arizona, attendees heard presentations and participated in workshops that discussed better integration of care, improved use of technology, and the future of healthcare and the Affordable Care Act.

Accountable care organizations can improve outcomes and patient experience while reducing costs through integrated care and better use of technology.

Scottsdale Health Partners’ success is derived from its physician engagement, care coordination and transformation, and meaningful IT usage, explained James Whitfill, MD, chief medical officer. The organization has also learned that direct contact with both patients and provider is critical to continuing that success.

As healthcare moves to value-based arrangements and delivery models like accountable care organizations (ACOs), the benefit of incorporating a pharmacist can be overlooked. Tina Joseph, PharmD, BCACP, and Reena Jones, PharmD, CPh, both from Nova Southeastern University, outlined how pharmacists can be integrated into ACOs in order to improve care and patient satisfaction, while reducing cost.

The National Quality Forum’s Measure Applications Partnership recently released guidelines on measures for the new Merit-Based Incentive Payment System and on cross-cutting issues for all federal healthcare programs.

If accountable care organizations (ACOs) are going to be successful, they need to learn from another and have meetings like the ACO & Emerging Healthcare Delivery Coalition's Spring Live Meeting, being held April 28-29 in Scottsdale, Arizona, to exchange good information, explained Michael Chernew, PhD, co-editor-in-chief of The American Journal of Managed Care. Dr Chernew will also sit on a panel discussion about the future state of healthcare in the United States during the ACO Coalition's meeting.

One of the greatest challenges for the healthcare industry as it moves to value-based payments is shifting from a short-term to a long-term mode of thinking, Farzad Mostashari, MD, chief executive officer of Aledade, explained at the National Association of ACOs Spring 2016 Conference.

The top stories in managed care include a recap of Patient-Centered Diabetes Care, the case for the Oncology Medical Home, UnitedHealth leaves Affordable Care Act exchanges in 2 states, and CMS expands alternative payment model for primary care.

In 2012, electronic health record use and participation in accountable care organization or patient-centered medical home initiatives were associated with performing care processes expected to improve healthcare outcomes.

Everyone in healthcare is currently grappling with what payment reform will look like in the coming years, and oncology is no exception. Payers, providers, and health policy experts reviewed ongoing changes in the healthcare system and shared their vision on what the future would look like.

In preparation for the Spring Live Meeting of the ACO & Emerging Healthcare Delivery Coalition, 2 speakers who will be at the meeting will participate in 2 30-minute tweetchats.

Implementing an accountable care organization well without having gone through the process of getting patient-centered medical home designation is a struggle, Jill Watson, MBA, chief executive officer of The Kansas City Metropolitan Physician Association, said at the National Association of ACOs Spring 2016 Conference.

This week in managed care, the top stories included new data on statin prescriptions, a trial found the PCSK9 inhibitor Repatha successfully lowered cholesterol, but an editorial said the price might be too high to be worth it, and Farzad Mostashari, MD, discussed care transformation.

Scottsdale Health Partners has improved coordinated care on both a physical and a virtual level through the creation of a secure texting connection for real-time collaboration, James Whitfill, MD, chief medical officer of Scottsdale Health Partners, explained at the National Association of Accountable Care Organizations’ Spring 2016 Conference.

The move to value-based payment is going well, but the real work has to be done on the care transformation side, Farzad Mostashari, MD, co-founder and chief executive of Aledade.

It looks like 2016 is shaping up to be the most pivotal year in healthcare policy in a long time.

There is a need for a new stop loss formula that ensures a level playing field and motivates accountable care organizations.

Anthony D. Slonim, MD, DrPH, president and chief executive officer for Renown Health and chair of The American Journal of Managed Care (AJMC)’s ACO and Emerging Healthcare Delivery Coalition, spoke to AJMC about what it means to be a physician leader, the industry’s move to population health, the ACO Coalition, and more.

The value of the ACO & Emerging Healthcare Delivery Coalition live meetings is the information exchange that happens among organizations that are all looking at the same problem but from different angles, said Tabatha Dragonberry.

Population health, healthcare value, innovations in healthcare, cost of care-these were just some of the topics discussed at the meeting.

The shared savings payments were for specialists in hip and knee replacements, knee arthroscopy, and pregnancy. These areas have been among CMS' top targets for savings, while New Jersey has been focused on reducing its high rate of C-sections.

A collaboration led by CMS and America’s Health Insurance Plans released 7 core sets of quality measures created to reduce complexity, decrease cost burden, and ensure high-quality care.

Howard C. Springer, the administrative director of strategy for accountable care services for Swedish Medical Center in Seattle, explained that the benefit he got out of attending one of the past ACO and Emerging Healthcare Delivery Coalition live meetings was the knowledge from people who have been in the business for a while.

Patrick Conway, MD, MSc, deputy administrator for innovation and quality and chief medical officer at CMS, describes the proposed changes to the Medicare Shared Savings Program and how they will assist accountable care organizations transitioning to tracks with more risks.

While the pace of payment reform is moving quickly, Patrick Conway, MD, MSc, deputy administrator for innovation and quality and chief medical officer at CMS, said he thinks about how to maintain that pace.

CMS has proposed changes to accountable care organizations benchmarks in the Medicare Shared Savings Program, as well as a way to better facilitate the transition to performance-based risk.

Accountable primary care is essential in lowering healthcare costs as a whole and making it care more accessible to patients. Debbie Zimmerman, MD, chief medical officer of Lumeris, discussed how to improve primary care and get primary care physicians aligned with the delivery of accountable care.